From the Guidelines

Yes, a Transthoracic Echocardiogram (TTE) is used for Rheumatic Heart Disease.

The World Heart Federation has developed echocardiographic criteria for the diagnosis of Rheumatic Heart Disease (RHD) using 2D, continuous-wave, and color-Doppler echocardiography 1.
These criteria define three categories: ‘definite RHD’, ‘borderline RHD’, and ‘normal’, with subcategories to reflect various disease patterns.
Handheld echocardiography has been shown to have high sensitivity and specificity for diagnosing RHD, with high accuracy when compared to standard echocardiography 1.
The 2023 World Heart Federation guidelines provide revised minimum echocardiographic criteria for the definitive diagnosis of RHD, a new classification of RHD, and management recommendations for early-stage RHD 1.

The diagnosis of RHD is based on the assessment of morphological features and the presence of pathological mitral and aortic regurgitation.
The criteria are modified for individuals aged over 20 years, taking into account the available evidence.
The use of handheld echocardiography and task sharing can facilitate active case finding in resource-limited settings.

Echocardiography is vastly superior to auscultation for detecting RHD, and the detection of early RHD by echocardiography can reduce the global burden of RHD.
The WHF 2023 guidelines provide a pragmatic and contemporary reference tool for clinical and research applications in RHD-endemic regions.

From the Research

TTE is used in the diagnosis and assessment of rheumatic heart disease, particularly in patients with rheumatic mitral stenosis 2, 3.
The study by 2 compared the results of TTE with transesophageal echocardiography (TEE) in 120 patients with rheumatic mitral stenosis and found that TEE was better than TTE in detecting left atrial thrombus.
Another study by 3 also found that TEE was superior to TTE in detecting left atrial thrombi, especially those located in the left atrial appendage and along the left atrial posterior wall.
However, TTE is still a valuable tool in the assessment of rheumatic heart disease, and is often used in conjunction with TEE to provide a more comprehensive evaluation of the patient's condition 2, 4.

TTE may not be as sensitive as TEE in detecting left atrial thrombi, particularly those located in the left atrial appendage and along the left atrial posterior wall 2, 3.
TTE may also have limitations in evaluating the mitral valve area and left atrial dimension, which are important parameters in the assessment of rheumatic mitral stenosis 5.
However, advances in TTE technology, such as the use of tissue Doppler, myocardial deformation imaging, and three-dimensional echocardiography, may help to improve its diagnostic accuracy and provide more detailed information on cardiac function and disease 6.

TTE is widely used in clinical practice to diagnose and assess rheumatic heart disease, and to guide treatment decisions 2, 4.
TTE is also used to monitor patients with rheumatic heart disease and to detect any changes in their condition over time 5.
The use of TTE in conjunction with TEE and other imaging modalities, such as cardiac magnetic resonance, can provide a more comprehensive evaluation of the patient's condition and help to improve patient outcomes 5, 3.